Elbow flexion contractures in neonatal brachial plexus palsy: A one-year comparison of dynamic orthosis and serial casting

Abstract

Objective Elbow flexion contractures are common complications of neonatal brachial plexus palsy, but evidence on how to treat these contractures is weak. This study compared the treatment of elbow flexion contractures using a dynamic orthosis or serial circular casting. Methods A randomized controlled trial was conducted with one-year follow-up. Children with an elbow flexion contracture of ≥30° were treated with either a night-worn dynamic orthosis for one year or serial casting for four weeks followed by night splinting. For pragmatic reasons, some participants were included in an open part of this study, this group was also analyzed separately. Degree of contracture and goal attainment scaling was evaluated at baseline and after 8, 20 and 54 weeks. Results 55 patients were analyzed in this trial, 32 of whom were randomized to treatment. At one-year follow-up of the randomized group, both dynamic splinting (median −8.5°, interquartile range [IQR] −13.5, −5) and serial casting (median −11.0°, IQR −16, −5) resulted in significant reduction of contracture ( P < 0 .001). The reduction was significantly greater with serial casting in the first 20 weeks, but not at one-year follow-up ( P = 0.683). In the entire cohort, the individual functional goals had been reached in 24 out of 32 cases (80%) of dynamic splinting and 18 out of 23 cases (82%) of serial casting, respectively. Conclusion The dynamic night orthosis is comparable to serial casting for treating elbow flexion contractures in children with brachial plexus birth injury. We recommend selecting one of these treatment modalities in close consultation with parents and patients.

Review of rehabilitation protocols for brachial plexus injury

“…Virtual reality and robotics combined to facilitate upper extremity pain management and sensory recovery after brachial plexus injury ( 44 ). The very first mention of dynamic orthoses as having a role in motor re-education came in 2018 ( 37 ), but more recent research has revealed that dynamic nocturnal orthoses are equally effective as continuous cast immobilization in treating elbow flexion contractures in kids with brachial plexus nerve birth injuries ( 45 ). As children’s upper extremities move less than those of adults, dynamic orthoses may only serve as a fixation device in children with brachial plexus injuries while offering more motor support in adults.…”

Brachial plexus birth injury: advances and controversies

“…The exact mechanism of development of the flexion contracture remains uncertain, but there appears to be shortening of the biceps and other elbow flexors relative to the humerus during growth (Nikolaou et al., 2011). Serial application of casts or orthoses may be helpful in preventing the development of elbow flexion contracture (Op de Coul et al., 2023). If the orthoses used to keep the elbow in extension aim to stretch the biceps muscle, it is more effective to make these in pronation.…”

The efficacy of electroacupuncture for cervical nerve edema and movement disorder caused by the brachial plexus injury: a case report

“…Previous studies have shown that surgical intervention is considered to be the final solution for clinical management of BPI, but it carries high risks and costs ( 5 ). In non-surgical treatments, local corticosteroid injections, splinting, and oral corticosteroids have shown significant short-term benefits but are prone to recurrence and may lead to complications such as mechanical or chemical nerve damage ( 6 ). Therefore, selecting the optimal treatment approach for BPI is crucial.…”